From the Beaumont Health, Departments of Orthopaedic Surgery and Research, Royal Oak, MI (Dr. Flierl, Dr. Sobh, and Dr. Baker), the Princeton HealthCare System, Department of Orthopaedic Surgery, Princeton, NJ (Dr. Culp), and the Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, IL (Dr. Sporer).
J Am Acad Orthop Surg. 2019 Oct 15;27(20):743-751. doi: 10.5435/JAAOS-D-18-00083.
Total knee arthroplasty (TKA) has been associated with notable improvements in health-related quality of life of patients with end-stage knee arthritis. Although most patients experience substantial symptomatic relief after TKA, up to 19% of patients are unsatisfied with their outcome. With the dramatic, projected increase in the number of TKAs performed annually, it is crucial to appreciate the various modes of failure associated with this procedure. A comprehensive understanding of the symptomatology and thorough clinical examination aid in identifying the etiology of ongoing knee pain. Ancillary testing including conventional laboratory analyses, imaging studies, and diagnostic injections supplement a thorough history and physical examination. In addition, novel laboratory markers, RNA/DNA-based tests, and novel imaging modalities are emerging as beneficial tools in evaluating patients with a painful TKA. A well-structured, algorithmic approach in the management of these patients is essential in correctly diagnosing the patient and optimizing clinical outcomes.
全膝关节置换术（TKA）可显著改善终末期膝关节关节炎患者的健康相关生活质量。尽管大多数患者在 TKA 后都能获得明显的症状缓解，但仍有高达 19%的患者对其治疗结果不满意。随着每年 TKA 数量的急剧增加，了解与该手术相关的各种失败模式至关重要。全面了解症状并进行彻底的临床检查有助于确定持续性膝关节疼痛的病因。辅助检查包括常规实验室分析、影像学研究和诊断性注射，以补充全面的病史和体格检查。此外，新型实验室标志物、基于 RNA/DNA 的检测和新型成像方式正成为评估膝关节疼痛患者的有益工具。对这些患者进行结构化、算法式的管理方法对于正确诊断患者和优化临床结果至关重要。
